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The most widely used grading system is the Nottingham scheme; details are provided in the discussion of breast cancer grade. The presence of estrogen and progesterone receptors in the cancer cell is important in guiding treatment. Those who do not test positive for these specific receptors will not be able to respond to hormone therapy, and this can affect their chance of survival depending upon what treatment options remain, the exact type of the cancer, and how advanced the disease is. In addition to hormone receptors, there are other cell surface proteins that may affect prognosis and treatment. HER2 status directs the course of treatment. Patients whose cancer cells are positive for HER2 have more aggressive disease and may be treated with the 39;targeted therapy39;, trastuzumab (Herceptin), a monoclonal antibody that targets this protein and improves the prognosis significantly.

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